Provider Demographics
NPI:1427288513
Name:MATHLIN, ATIBA DENNIS (IDC)
Entity type:Individual
Prefix:MR
First Name:ATIBA
Middle Name:DENNIS
Last Name:MATHLIN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS PAUL HAMILTON DDG 60
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96667-1278
Mailing Address - Country:US
Mailing Address - Phone:619-556-9299
Mailing Address - Fax:
Practice Address - Street 1:USS PAUL HAMILTON DDG 60
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96667-1278
Practice Address - Country:US
Practice Address - Phone:619-556-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman